Provider Demographics
NPI:1700807955
Name:ABC DENTISTRY, PA
Entity Type:Organization
Organization Name:ABC DENTISTRY, PA
Other - Org Name:ABC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:JABBARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-593-3300
Mailing Address - Street 1:1214 E HOUSTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4754
Mailing Address - Country:US
Mailing Address - Phone:281-593-3300
Mailing Address - Fax:281-593-1616
Practice Address - Street 1:1214 E HOUSTON ST STE D
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4754
Practice Address - Country:US
Practice Address - Phone:281-593-3300
Practice Address - Fax:281-593-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty